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zarfkitty

Blue Cross & Enterolab

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Since it only cost me a little time and a stamp, I went ahead and sent claims forms to Blue Cross / Blue Shield for my Enterolab tests. I also sent my daughter's. I'm not holding my breath.

What responses have people gotten back from BCBS?

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Since it only cost me a little time and a stamp, I went ahead and sent claims forms to Blue Cross / Blue Shield for my Enterolab tests. I also sent my daughter's. I'm not holding my breath.

What responses have people gotten back from BCBS?

My mother got a genetic test run through another lab after my positive diagnosis. At first neither Medicare or Anthem ( BCBS) was willing to pay for the test. I contacted my primary care doctor and they in turn contacted the lab (LabCorp) and provided some additional information. I don't know whether it was a statement that this was done as a preventitive measure for her and other relatives or something was coded differently. My primary care doctor did say we had to be careful in what went on my mother's medical record as it may affect the cost of her supplemental insurance. She tested postive for DQ2 but has never had any symptoms.

I think there are a lot of factors to consider as to whether or not insurance will pay:

(1) Did the test result in weak positive, positive, or negative. ( a negative result may lead the insurance company to think the test was not necessary).

(2) Was there a family history issue that caused you to request the test to start with.

(3) Did the person getting tested exhibit sufficient symptoms to warrant doing these tests.

(4) Did a doctor recommend that you do these tests.

My honest opinion is that the insurance companies as a whole don't have a clear understanding of how blood testing relates to early diagnosis of something like Celiac Disease. The people I talked to at both Anthem and Medicare did not have a good understanding of gluten intolerance/Celiac. I believe if Entrolab detects even the slightest amount of response to gluten (gluten sensitivity), it would be their recommendation that the person go on a gluten-free diet. At least long enough to see if it helps. Somebody correct me if this is wrong. That said if a person does go on the diet and responds in a postive manner then it would in the long run save the insurance company money.

The quality of one's insurance policy and any supporting information provided is probably the biggest factor in determining who will or will not pay for these type of tests.

Tom

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When I was considering Enterolab for my son, I called bluecross and read them the medical codes for the tests and I was told that I would be reimbursed for the costs for an out of network provider. Of course, labs are considered major medical, so the detectable is applied.

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My insurance company wouldn't reimburse for it. I spent a good chunk of time explaining that no allergist in the city would be able to test for a non-allergy casein intolerance but they didn't seem to "get it". I paid for it myself. BUT, if it had been positive, I don't think I'd want that on my medical records and if insurance paid for it I think it would be on the record. So I'm not too upset about it.

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Thanks everyone. I've already met my deductible this year, so maybe I'll get a little money back. My daughter hasn't met her deductible but getting a little back is better than nothing. Still not holding my breath though. Hehe.

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